Department of Neurosurgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA.
J Neurointerv Surg. 2010 Mar;2(1):11-5. doi: 10.1136/jnis.2009.001685. Epub 2009 Dec 4.
The management of unruptured intracranial aneurysms in the elderly remains controversial. Treatment risks are thought to be higher in this group. Large series assessing endovascular treatment of unruptured intracranial aneurysms in the elderly are lacking. Our single center endovascular experience in treating unruptured intracranial aneurysms in the elderly is presented.
77 patients, 70 years or older, were referred to the endovascular neurosurgery service for treatment of an unruptured intracranial aneurysm between February 2000 and May 2008. Hospital records, operative reports, angiograms and radiology reports were reviewed and analyzed retrospectively.
99 aneurysms were treated in 77 patients in 102 procedures. Mean patient age was 75±4 years, and the average aneurysm size was 11±7 mm. Adjuvant techniques were used in 66% of cases. Endovascular procedures included coiling alone (32%), balloon assisted coiling (19%), stent assisted coiling (37%), balloon assisted stent and coiling (8%), stent only (1%) and glue (2%). The permanent morbidity and mortality rates were 1% and 3%, respectively. Four adverse events were attributed to the patient's age. Posterior circulation aneurysms were associated with more adverse events (41%) than anterior circulation aneurysms (14%). Endovascular treatments using adjuvant techniques were associated with a higher complication rate than coiling alone.
With only a 4% permanent rate of neurological morbidity and mortality, endovascular treatment of unruptured aneurysms can be performed safely in the elderly. Age should not be the limiting factor when considering endovascular therapy.
老年人颅内未破裂动脉瘤的治疗仍存在争议。人们认为，该人群的治疗风险更高。目前缺乏评估老年人颅内未破裂动脉瘤血管内治疗的大型系列研究。我们报告了单中心治疗老年人颅内未破裂动脉瘤的血管内经验。
2000 年 2 月至 2008 年 5 月，共有 77 名 70 岁或以上的患者因颅内未破裂动脉瘤被转诊至血管神经外科服务中心进行治疗。回顾性分析了医院病历、手术报告、血管造影和放射学报告。
77 例患者共 102 次治疗了 99 个动脉瘤。患者平均年龄为 75±4 岁，平均动脉瘤大小为 11±7mm。在 66%的病例中使用了辅助技术。血管内治疗包括单纯线圈栓塞（32%）、球囊辅助线圈栓塞（19%）、支架辅助线圈栓塞（37%）、球囊辅助支架和线圈栓塞（8%）、支架单纯栓塞（1%）和胶（2%）。永久性发病率和死亡率分别为 1%和 3%。有 4 例不良事件归因于患者年龄。后循环动脉瘤的不良事件发生率（41%）高于前循环动脉瘤（14%）。使用辅助技术的血管内治疗比单纯线圈栓塞的并发症发生率更高。
对于老年人颅内未破裂动脉瘤的治疗，神经功能永久性发病率和死亡率仅为 4%，血管内治疗可以安全进行。在考虑血管内治疗时，年龄不应成为限制因素。
